CEN CAL

CALIFORNIA DIVING & AQUATIC STUDIES SCHOLARSHIP

APPLICATION FORM

Date: ________________________________

Name: _____________________________________________________________________________________

First Middle Last

Home Address: ______________________________________________________________________________

City, State, Zip: ______________________________________________________________________________

School Attending: ____________________________________________________________________________

School Address: ______________________________________________________________________________

City, State, Zip: ______________________________________________________________________________

Phone home: __________________Phone at School: ____________________E-Mail_______________________

Major Course of Study: ________________________________________________________________________

Total Units Completed as of this Date: ____________________________________________________________

Grade Level: ______________________________________GPA: _____________________________________

Primary Marine Interest: _______________________________________________________________________

___________________________________________________________________________________________

SCUBA Certifications:

Basic/Openwater: Date ________________Agency ____________________Cert.# ________________________

Most Advanced: Level________________ Date ____________Agency _____________Cert.# _______________

Listing of Honors, Awards, Specialty Classes, Relevant Memberships, Community

Service and any other applicable activities:

___________________________________________________________________________________________

(Use additional paper if necessary.)

Signature:

_________________________________________________________